Scaling and Root Planing Appointments
I was recently asked the following question: Last week I had two patients scheduled for periodontal maintenance. When they came in, they both had several areas of pocketing with bleeding. I told them that if we didn’t see an improvement at their next visit, I would like to do scaling and root planing in those areas. They both agreed and I treatment planned as such. My question is, should we be waiting three months for their next visit to do the SRP, and if so, what about their periodontal maintenance visit and getting the rest of their mouth cleaned?
There are many different approaches you may want to take with this. You have already told the patients that if you don’t see an improvement in the numbers and bleeding, you want to do root planing in those areas. You will not be doing the root planing at the next visit, but you will be doing the periodontal maintenance appointment to determine the need for root planing, which will be done as soon as possible after the periodontal maintenance appointment.
Their next appointment should have been scheduled for a three-month periodontal maintenance appointment. At this time, you can do the full mouth probing and evaluate their bleeding not only during probing, but also during instrumentation. If there is still a lot of bleeding upon probing or during instrumentation, then the patient will return for the root planing that you have already given them a treatment plan for. This appointment may be as soon as the next day, then the next appointment after the root planing will be a three-month periodontal maintenance appointment.
If all the areas of concern have responded and there is no bleeding upon probing and minimal or no bleeding upon instrumentation, then you will have them back in three months for their next periodontal maintenance.
Some patients will step up their home care and get the results you have been looking for all along. They will stay on their three-month periodontal maintenance as long as their state of health stays where they are that day. It is recommended that you continuously evaluate not only your periodontal patients, but your healthy prophylactic patients as well, as you do not want to wait for there to be a bigger problem.
Another approach you can take with this type of patient – depending on the severity of their disease, personality type, trust level with the practice, and patient compliance – is to go ahead and treatment plan for the root planing like you did, but have them back immediately. This would apply to patients with deeper pockets, as waiting three more months may make quite a difference in their overall periodontal health. Also, if the patient has massive amounts of bleeding upon probing, it would be recommended to treatment plan for the root planing as soon as possible, as we know this is a sign that the disease is active.
Being aware of your patients verbal and particularly their non-verbal communication may make a difference in whether or not you hold off for three months, or move forward immediately. Regardless, the periodontal maintenance appointment will be completed that day and when they return, you will want to complete the periodontal maintenance appointment and have them return for the root planing.
It is not recommended to treatment plan according to insurance limitations. However, it is recommended to try and maximize the patient’s insurance benefits whenever possible so they are paying the least amount of money out-of-pocket. Many insurance companies will not pay for periodontal maintenance for a specified amount of time after root planing. So, if you do the root planing in three months and then do the periodontal maintenance, the result may be that the patient has to pay 100% out-of-pocket.
However, if you move forward with the periodontal maintenance, treat all of the areas and then have the patient back the next day, they may have a lot less out-of-pocket. You are not compromising quality of care, and the patient is happy. This also gives you another chance to evaluate the patient’s mouth to see if they still need root planing, and you will know the amount of time to schedule the patient because you know they will have a periodontal maintenance appointment.
The periodontal maintenance appointment is absolutely necessary. The teeth that were not treatment planned to be root planed still need to be taken care of in a timely manner to prevent them from digressing into an unhealthy periodontal state.
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